Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$58,979.29

Service Code	MSDRG 474
Min. Negotiated Rate	$31,035.24
Max. Negotiated Rate	$58,979.29
Rate for Payer: Aetna Medicare	$32,668.67
Rate for Payer: Allen County Amish Medical Aid Commercial	$40,835.84
Rate for Payer: Amish Plain Church Group Commercial	$40,835.84
Rate for Payer: BCBS MAPPO	$32,668.67
Rate for Payer: BCN Medicare Advantage	$32,668.67
Rate for Payer: Health Alliance Plan Medicare Advantage	$32,668.67
Rate for Payer: Humana Choice PPO Medicare	$32,668.67
Rate for Payer: Mclaren Medicare	$32,668.67
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$34,302.10
Rate for Payer: MI Amish Medical Board Commercial	$37,568.97
Rate for Payer: Molina Medicare/Medicaid	$35,935.54
Rate for Payer: PACE Medicare	$31,035.24
Rate for Payer: PACE SWMI	$32,668.67
Rate for Payer: PHP Commercial	$35,935.54
Rate for Payer: PHP Medicare Advantage	$32,668.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$58,979.29
Rate for Payer: Priority Health Medicare	$32,668.67
Rate for Payer: Priority Health Narrow Network	$47,183.44
Rate for Payer: Railroad Medicare Medicare	$32,668.67
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$32,668.67
Rate for Payer: UHC Exchange	$50,636.44
Rate for Payer: UHCCP DNSP	$32,668.67
Rate for Payer: VA VA	$32,668.67

AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$16,214.53

Service Code	MSDRG 476
Min. Negotiated Rate	$9,740.70
Max. Negotiated Rate	$16,214.53
Rate for Payer: Aetna Medicare	$10,253.37
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,816.71
Rate for Payer: Amish Plain Church Group Commercial	$12,816.71
Rate for Payer: BCBS MAPPO	$10,253.37
Rate for Payer: BCN Medicare Advantage	$10,253.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,253.37
Rate for Payer: Humana Choice PPO Medicare	$10,253.37
Rate for Payer: Mclaren Medicare	$10,253.37
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,766.04
Rate for Payer: MI Amish Medical Board Commercial	$11,791.38
Rate for Payer: Molina Medicare/Medicaid	$11,278.71
Rate for Payer: PACE Medicare	$9,740.70
Rate for Payer: PACE SWMI	$10,253.37
Rate for Payer: PHP Commercial	$11,278.71
Rate for Payer: PHP Medicare Advantage	$10,253.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$16,214.53
Rate for Payer: Priority Health Medicare	$10,253.37
Rate for Payer: Priority Health Narrow Network	$12,971.63
Rate for Payer: Railroad Medicare Medicare	$10,253.37
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,253.37
Rate for Payer: UHC Exchange	$15,892.72
Rate for Payer: UHCCP DNSP	$10,253.37
Rate for Payer: VA VA	$10,253.37

AMPUTATION OF LOWER LIMB EXCEPT TOES

Facility

$8,878.33

Service Code	APR-DRG 3051
Min. Negotiated Rate	$8,027.07
Max. Negotiated Rate	$8,878.33
Rate for Payer: BCBS Complete	$8,878.33
Rate for Payer: Mclaren Medicaid	$8,455.55
Rate for Payer: Meridian Medicaid	$8,878.33
Rate for Payer: PHP Medicaid	$8,027.07
Rate for Payer: Priority Health Choice Medicaid	$8,455.55
Rate for Payer: UHC Medicaid	$8,455.55
Rate for Payer: UHCCP Medicaid	$8,455.55

AMPUTATION OF LOWER LIMB EXCEPT TOES

Facility

$9,805.83

Service Code	APR-DRG 3052
Min. Negotiated Rate	$8,865.64
Max. Negotiated Rate	$9,805.83
Rate for Payer: BCBS Complete	$9,805.83
Rate for Payer: Mclaren Medicaid	$9,338.89
Rate for Payer: Meridian Medicaid	$9,805.83
Rate for Payer: PHP Medicaid	$8,865.64
Rate for Payer: Priority Health Choice Medicaid	$9,338.89
Rate for Payer: UHC Medicaid	$9,338.89
Rate for Payer: UHCCP Medicaid	$9,338.89

AMPUTATION OF LOWER LIMB EXCEPT TOES

Facility

$14,547.99

Service Code	APR-DRG 3053
Min. Negotiated Rate	$13,153.12
Max. Negotiated Rate	$14,547.99
Rate for Payer: BCBS Complete	$14,547.99
Rate for Payer: Mclaren Medicaid	$13,855.22
Rate for Payer: Meridian Medicaid	$14,547.99
Rate for Payer: PHP Medicaid	$13,153.12
Rate for Payer: Priority Health Choice Medicaid	$13,855.22
Rate for Payer: UHC Medicaid	$13,855.22
Rate for Payer: UHCCP Medicaid	$13,855.22

AMPUTATION OF LOWER LIMB EXCEPT TOES

Facility

$19,892.31

Service Code	APR-DRG 3054
Min. Negotiated Rate	$17,985.03
Max. Negotiated Rate	$19,892.31
Rate for Payer: BCBS Complete	$19,892.31
Rate for Payer: Mclaren Medicaid	$18,945.06
Rate for Payer: Meridian Medicaid	$19,892.31
Rate for Payer: PHP Medicaid	$17,985.03
Rate for Payer: Priority Health Choice Medicaid	$18,945.06
Rate for Payer: UHC Medicaid	$18,945.06
Rate for Payer: UHCCP Medicaid	$18,945.06

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility

$25,695.68

Service Code	MSDRG 617
Min. Negotiated Rate	$14,461.80
Max. Negotiated Rate	$25,695.68
Rate for Payer: Aetna Medicare	$15,222.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$19,028.69
Rate for Payer: Amish Plain Church Group Commercial	$19,028.69
Rate for Payer: BCBS MAPPO	$15,222.95
Rate for Payer: BCN Medicare Advantage	$15,222.95
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,222.95
Rate for Payer: Humana Choice PPO Medicare	$15,222.95
Rate for Payer: Mclaren Medicare	$15,222.95
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15,984.10
Rate for Payer: MI Amish Medical Board Commercial	$17,506.39
Rate for Payer: Molina Medicare/Medicaid	$16,745.24
Rate for Payer: PACE Medicare	$14,461.80
Rate for Payer: PACE SWMI	$15,222.95
Rate for Payer: PHP Commercial	$16,745.24
Rate for Payer: PHP Medicare Advantage	$15,222.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$25,695.68
Rate for Payer: Priority Health Medicare	$15,222.95
Rate for Payer: Priority Health Narrow Network	$20,556.54
Rate for Payer: Railroad Medicare Medicare	$15,222.95
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$15,222.95
Rate for Payer: UHC Exchange	$23,595.57
Rate for Payer: UHCCP DNSP	$15,222.95
Rate for Payer: VA VA	$15,222.95

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility

$47,912.69

Service Code	MSDRG 616
Min. Negotiated Rate	$25,524.67
Max. Negotiated Rate	$47,912.69
Rate for Payer: Aetna Medicare	$26,868.07
Rate for Payer: Allen County Amish Medical Aid Commercial	$33,585.09
Rate for Payer: Amish Plain Church Group Commercial	$33,585.09
Rate for Payer: BCBS MAPPO	$26,868.07
Rate for Payer: BCN Medicare Advantage	$26,868.07
Rate for Payer: Health Alliance Plan Medicare Advantage	$26,868.07
Rate for Payer: Humana Choice PPO Medicare	$26,868.07
Rate for Payer: Mclaren Medicare	$26,868.07
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$28,211.47
Rate for Payer: MI Amish Medical Board Commercial	$30,898.28
Rate for Payer: Molina Medicare/Medicaid	$29,554.88
Rate for Payer: PACE Medicare	$25,524.67
Rate for Payer: PACE SWMI	$26,868.07
Rate for Payer: PHP Commercial	$29,554.88
Rate for Payer: PHP Medicare Advantage	$26,868.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$47,912.69
Rate for Payer: Priority Health Medicare	$26,868.07
Rate for Payer: Priority Health Narrow Network	$38,330.15
Rate for Payer: Railroad Medicare Medicare	$26,868.07
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$26,868.07
Rate for Payer: UHC Exchange	$41,645.51
Rate for Payer: UHCCP DNSP	$26,868.07
Rate for Payer: VA VA	$26,868.07

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility

$19,485.74

Service Code	MSDRG 618
Min. Negotiated Rate	$11,369.58
Max. Negotiated Rate	$19,485.74
Rate for Payer: Aetna Medicare	$11,967.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$14,959.98
Rate for Payer: Amish Plain Church Group Commercial	$14,959.98
Rate for Payer: BCBS MAPPO	$11,967.98
Rate for Payer: BCN Medicare Advantage	$11,967.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$11,967.98
Rate for Payer: Humana Choice PPO Medicare	$11,967.98
Rate for Payer: Mclaren Medicare	$11,967.98
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$12,566.38
Rate for Payer: MI Amish Medical Board Commercial	$13,763.18
Rate for Payer: Molina Medicare/Medicaid	$13,164.78
Rate for Payer: PACE Medicare	$11,369.58
Rate for Payer: PACE SWMI	$11,967.98
Rate for Payer: PHP Commercial	$13,164.78
Rate for Payer: PHP Medicare Advantage	$11,967.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$19,485.74
Rate for Payer: Priority Health Medicare	$11,967.98
Rate for Payer: Priority Health Narrow Network	$15,588.59
Rate for Payer: Railroad Medicare Medicare	$11,967.98
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$11,967.98
Rate for Payer: UHC Exchange	$18,550.37
Rate for Payer: UHCCP DNSP	$11,967.98
Rate for Payer: VA VA	$11,967.98

ANAL AND PERINEAL PROCEDURES

Facility

$6,211.89

Service Code	APR-DRG 2262
Min. Negotiated Rate	$5,616.29
Max. Negotiated Rate	$6,211.89
Rate for Payer: BCBS Complete	$6,211.89
Rate for Payer: Mclaren Medicaid	$5,916.08
Rate for Payer: Meridian Medicaid	$6,211.89
Rate for Payer: PHP Medicaid	$5,616.29
Rate for Payer: Priority Health Choice Medicaid	$5,916.08
Rate for Payer: UHC Medicaid	$5,916.08
Rate for Payer: UHCCP Medicaid	$5,916.08

ANAL AND PERINEAL PROCEDURES

Facility

$11,526.24

Service Code	APR-DRG 2263
Min. Negotiated Rate	$10,421.10
Max. Negotiated Rate	$11,526.24
Rate for Payer: BCBS Complete	$11,526.24
Rate for Payer: Mclaren Medicaid	$10,977.37
Rate for Payer: Meridian Medicaid	$11,526.24
Rate for Payer: PHP Medicaid	$10,421.10
Rate for Payer: Priority Health Choice Medicaid	$10,977.37
Rate for Payer: UHC Medicaid	$10,977.37
Rate for Payer: UHCCP Medicaid	$10,977.37

ANAL AND PERINEAL PROCEDURES

Facility

$18,679.80

Service Code	APR-DRG 2264
Min. Negotiated Rate	$16,888.77
Max. Negotiated Rate	$18,679.80
Rate for Payer: BCBS Complete	$18,679.80
Rate for Payer: Mclaren Medicaid	$17,790.28
Rate for Payer: Meridian Medicaid	$18,679.80
Rate for Payer: PHP Medicaid	$16,888.77
Rate for Payer: Priority Health Choice Medicaid	$17,790.28
Rate for Payer: UHC Medicaid	$17,790.28
Rate for Payer: UHCCP Medicaid	$17,790.28

ANAL AND PERINEAL PROCEDURES

Facility

$5,690.37

Service Code	APR-DRG 2261
Min. Negotiated Rate	$5,144.77
Max. Negotiated Rate	$5,690.37
Rate for Payer: BCBS Complete	$5,690.37
Rate for Payer: Mclaren Medicaid	$5,419.40
Rate for Payer: Meridian Medicaid	$5,690.37
Rate for Payer: PHP Medicaid	$5,144.77
Rate for Payer: Priority Health Choice Medicaid	$5,419.40
Rate for Payer: UHC Medicaid	$5,419.40
Rate for Payer: UHCCP Medicaid	$5,419.40

ANAL AND STOMAL PROCEDURES WITH CC

Facility

$17,981.34

Service Code	MSDRG 348
Min. Negotiated Rate	$10,620.48
Max. Negotiated Rate	$17,981.34
Rate for Payer: Aetna Medicare	$11,179.45
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,974.31
Rate for Payer: Amish Plain Church Group Commercial	$13,974.31
Rate for Payer: BCBS MAPPO	$11,179.45
Rate for Payer: BCN Medicare Advantage	$11,179.45
Rate for Payer: Health Alliance Plan Medicare Advantage	$11,179.45
Rate for Payer: Humana Choice PPO Medicare	$11,179.45
Rate for Payer: Mclaren Medicare	$11,179.45
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,738.42
Rate for Payer: MI Amish Medical Board Commercial	$12,856.37
Rate for Payer: Molina Medicare/Medicaid	$12,297.40
Rate for Payer: PACE Medicare	$10,620.48
Rate for Payer: PACE SWMI	$11,179.45
Rate for Payer: PHP Commercial	$12,297.40
Rate for Payer: PHP Medicare Advantage	$11,179.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$17,981.34
Rate for Payer: Priority Health Medicare	$11,179.45
Rate for Payer: Priority Health Narrow Network	$14,385.07
Rate for Payer: Railroad Medicare Medicare	$11,179.45
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$11,179.45
Rate for Payer: UHC Exchange	$17,328.15
Rate for Payer: UHCCP DNSP	$11,179.45
Rate for Payer: VA VA	$11,179.45

ANAL AND STOMAL PROCEDURES WITH MCC

Facility

$31,538.79

Service Code	MSDRG 347
Min. Negotiated Rate	$17,371.36
Max. Negotiated Rate	$31,538.79
Rate for Payer: Aetna Medicare	$18,285.64
Rate for Payer: Allen County Amish Medical Aid Commercial	$22,857.05
Rate for Payer: Amish Plain Church Group Commercial	$22,857.05
Rate for Payer: BCBS MAPPO	$18,285.64
Rate for Payer: BCN Medicare Advantage	$18,285.64
Rate for Payer: Health Alliance Plan Medicare Advantage	$18,285.64
Rate for Payer: Humana Choice PPO Medicare	$18,285.64
Rate for Payer: Mclaren Medicare	$18,285.64
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$19,199.92
Rate for Payer: MI Amish Medical Board Commercial	$21,028.49
Rate for Payer: Molina Medicare/Medicaid	$20,114.20
Rate for Payer: PACE Medicare	$17,371.36
Rate for Payer: PACE SWMI	$18,285.64
Rate for Payer: PHP Commercial	$20,114.20
Rate for Payer: PHP Medicare Advantage	$18,285.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$31,538.79
Rate for Payer: Priority Health Medicare	$18,285.64
Rate for Payer: Priority Health Narrow Network	$25,231.03
Rate for Payer: Railroad Medicare Medicare	$18,285.64
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$18,285.64
Rate for Payer: UHC Exchange	$28,342.74
Rate for Payer: UHCCP DNSP	$18,285.64
Rate for Payer: VA VA	$18,285.64

ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC

Facility

$12,436.98

Service Code	MSDRG 349
Min. Negotiated Rate	$7,622.67
Max. Negotiated Rate	$12,436.98
Rate for Payer: Aetna Medicare	$8,023.86
Rate for Payer: Allen County Amish Medical Aid Commercial	$10,029.83
Rate for Payer: Amish Plain Church Group Commercial	$10,029.83
Rate for Payer: BCBS MAPPO	$8,023.86
Rate for Payer: BCN Medicare Advantage	$8,023.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,023.86
Rate for Payer: Humana Choice PPO Medicare	$8,023.86
Rate for Payer: Mclaren Medicare	$8,023.86
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$8,425.05
Rate for Payer: MI Amish Medical Board Commercial	$9,227.44
Rate for Payer: Molina Medicare/Medicaid	$8,826.25
Rate for Payer: PACE Medicare	$7,622.67
Rate for Payer: PACE SWMI	$8,023.86
Rate for Payer: PHP Commercial	$8,826.25
Rate for Payer: PHP Medicare Advantage	$8,023.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$11,961.00
Rate for Payer: Priority Health Medicare	$8,023.86
Rate for Payer: Priority Health Narrow Network	$9,568.80
Rate for Payer: Railroad Medicare Medicare	$8,023.86
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$8,023.86
Rate for Payer: UHC Exchange	$12,436.98
Rate for Payer: UHCCP DNSP	$8,023.86
Rate for Payer: VA VA	$8,023.86

ANGINA PECTORIS

Facility

$10,553.98

Service Code	MSDRG 311
Min. Negotiated Rate	$6,468.57
Max. Negotiated Rate	$10,553.98
Rate for Payer: Aetna Medicare	$6,809.02
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,511.27
Rate for Payer: Amish Plain Church Group Commercial	$8,511.27
Rate for Payer: BCBS MAPPO	$6,809.02
Rate for Payer: BCN Medicare Advantage	$6,809.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,809.02
Rate for Payer: Humana Choice PPO Medicare	$6,809.02
Rate for Payer: Mclaren Medicare	$6,809.02
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,149.47
Rate for Payer: MI Amish Medical Board Commercial	$7,830.37
Rate for Payer: Molina Medicare/Medicaid	$7,489.92
Rate for Payer: PACE Medicare	$6,468.57
Rate for Payer: PACE SWMI	$6,809.02
Rate for Payer: PHP Commercial	$7,489.92
Rate for Payer: PHP Medicare Advantage	$6,809.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$9,643.26
Rate for Payer: Priority Health Medicare	$6,809.02
Rate for Payer: Priority Health Narrow Network	$7,714.61
Rate for Payer: Railroad Medicare Medicare	$6,809.02
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,809.02
Rate for Payer: UHC Exchange	$10,553.98
Rate for Payer: UHCCP DNSP	$6,809.02
Rate for Payer: VA VA	$6,809.02

ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS

Facility

$2,831.02

Service Code	APR-DRG 1981
Min. Negotiated Rate	$2,559.58
Max. Negotiated Rate	$2,831.02
Rate for Payer: BCBS Complete	$2,831.02
Rate for Payer: Mclaren Medicaid	$2,696.20
Rate for Payer: Meridian Medicaid	$2,831.02
Rate for Payer: PHP Medicaid	$2,559.58
Rate for Payer: Priority Health Choice Medicaid	$2,696.20
Rate for Payer: UHC Medicaid	$2,696.20
Rate for Payer: UHCCP Medicaid	$2,696.20

ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS

Facility

$4,420.09

Service Code	APR-DRG 1983
Min. Negotiated Rate	$3,996.29
Max. Negotiated Rate	$4,420.09
Rate for Payer: BCBS Complete	$4,420.09
Rate for Payer: Mclaren Medicaid	$4,209.61
Rate for Payer: Meridian Medicaid	$4,420.09
Rate for Payer: PHP Medicaid	$3,996.29
Rate for Payer: Priority Health Choice Medicaid	$4,209.61
Rate for Payer: UHC Medicaid	$4,209.61
Rate for Payer: UHCCP Medicaid	$4,209.61

ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS

Facility

$9,253.80

Service Code	APR-DRG 1984
Min. Negotiated Rate	$8,366.54
Max. Negotiated Rate	$9,253.80
Rate for Payer: BCBS Complete	$9,253.80
Rate for Payer: Mclaren Medicaid	$8,813.14
Rate for Payer: Meridian Medicaid	$9,253.80
Rate for Payer: PHP Medicaid	$8,366.54
Rate for Payer: Priority Health Choice Medicaid	$8,813.14
Rate for Payer: UHC Medicaid	$8,813.14
Rate for Payer: UHCCP Medicaid	$8,813.14

ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS

Facility

$3,340.54

Service Code	APR-DRG 1982
Min. Negotiated Rate	$3,020.25
Max. Negotiated Rate	$3,340.54
Rate for Payer: BCBS Complete	$3,340.54
Rate for Payer: Mclaren Medicaid	$3,181.47
Rate for Payer: Meridian Medicaid	$3,340.54
Rate for Payer: PHP Medicaid	$3,020.25
Rate for Payer: Priority Health Choice Medicaid	$3,181.47
Rate for Payer: UHC Medicaid	$3,181.47
Rate for Payer: UHCCP Medicaid	$3,181.47

ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION

Facility

$286.66

Service Code	HCPCS J0348
Hospital Charge Code	88093
Hospital Revenue Code	636
Min. Negotiated Rate	$215.00
Max. Negotiated Rate	$286.66
Rate for Payer: Aetna Commercial	$258.00
Rate for Payer: ASR ASR	$278.06
Rate for Payer: BCBS Trust/PPO	$235.41
Rate for Payer: BCN Commercial	$235.41
Rate for Payer: Cash Price	$229.33
Rate for Payer: Cofinity Commercial	$269.46
Rate for Payer: Encore Health Key Benefits Commercial	$229.33
Rate for Payer: Healthscope Commercial	$278.06
Rate for Payer: Healthscope Whirlpool	$286.66
Rate for Payer: Mclaren Commercial	$258.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.66
Rate for Payer: Nomi Health Commercial	$235.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$215.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$252.26

ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION

Facility

$286.66

Service Code	HCPCS J0348
Hospital Charge Code	88093
Hospital Revenue Code	636
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$286.66
Rate for Payer: Aetna Commercial	$258.00
Rate for Payer: Aetna Medicare	$106.07
Rate for Payer: ASR ASR	$278.06
Rate for Payer: BCBS Complete	$114.67
Rate for Payer: BCBS Trust/PPO	$236.35
Rate for Payer: BCN Commercial	$236.35
Rate for Payer: Cash Price	$229.33
Rate for Payer: Cash Price	$229.33
Rate for Payer: Cofinity Commercial	$269.46
Rate for Payer: Encore Health Key Benefits Commercial	$229.33
Rate for Payer: Healthscope Commercial	$278.06
Rate for Payer: Healthscope Whirlpool	$286.66
Rate for Payer: Mclaren Commercial	$258.00
Rate for Payer: MI Amish Medical Board Commercial	$229.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.66
Rate for Payer: Nomi Health Commercial	$235.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$215.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$0.53
Rate for Payer: Priority Health Narrow Network	$0.42
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$252.26

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$8,639.64

Service Code	APR-DRG 0593
Min. Negotiated Rate	$7,811.27
Max. Negotiated Rate	$8,639.64
Rate for Payer: BCBS Complete	$8,639.64
Rate for Payer: Mclaren Medicaid	$8,228.23
Rate for Payer: Meridian Medicaid	$8,639.64
Rate for Payer: PHP Medicaid	$7,811.27
Rate for Payer: Priority Health Choice Medicaid	$8,228.23
Rate for Payer: UHC Medicaid	$8,228.23
Rate for Payer: UHCCP Medicaid	$8,228.23

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$4,173.23

Service Code	APR-DRG 0591
Min. Negotiated Rate	$3,773.10
Max. Negotiated Rate	$4,173.23
Rate for Payer: BCBS Complete	$4,173.23
Rate for Payer: Mclaren Medicaid	$3,974.50
Rate for Payer: Meridian Medicaid	$4,173.23
Rate for Payer: PHP Medicaid	$3,773.10
Rate for Payer: Priority Health Choice Medicaid	$3,974.50
Rate for Payer: UHC Medicaid	$3,974.50
Rate for Payer: UHCCP Medicaid	$3,974.50

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